Experiences of midwifery care in English prisons

Abstract

Background: In the United Kingdom (UK), all prisoners must receive healthcare equivalent to that available in the community. However, evidence suggests that equality in healthcare provision for perinatal women in UK prisons is not always achieved. The aim of this research was to examine pregnant women prisoners' and custody staffs' experiences and perceptions of midwifery care in English prisons.

Methods: A qualitative approach based on institutional ethnography was used to research women's experiences in three English prisons over a period of 10 months. In total, 28 women participated in audio-recorded, semi-structured interviews. Ten staff members were interviewed, including six prison service staff and four health care personnel. Ten months of prison fieldwork enabled observations of everyday prison life. NVivo was used for data organization with an inductive thematic analysis method.

Results: Women's experiences included: disempowerment due to limited choice; fear of birthing alone; and a lack of information about rights, with a sense of not receiving entitlements. Some women reported favorably on the continuity of midwifery care provided. There was confusion around the statutory role of UK midwifery.

Discussion: Experiences of perinatal prisoners contrast starkly with best midwifery practice-women are unable to choose their care provider, their birth companions, or their place of birth. In addition, a reliance upon "good behavior" in return for appropriate treatment may be detrimental to the health, safety, and well-being of the pregnant woman and her unborn baby.

Conclusion: Prison is an adverse environment for a pregnant woman. This study provides key insights into imprisoned women's experiences of midwifery care in England and shows that midwives play an essential role in ensuring that perinatal prisoners receive safe, high-quality, respectful care.

Keywords: institutions; midwifery; pregnancy; prison; women's health.